MEDICARE: DR. STEVEN E CROVATTO DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN14107	FL

General Provider Information

NPI Number	:	1942357447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEVEN E CROVATTO DMD

Provider Business Mailing Address
First Line	:	105 FOXRIDGE RD
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-5731
Country	:	US
Telephone Number	:	904-272-0800
Fax Number	:	904-272-4923

Provider Business Practice Location Address
First Line	:	105 FOXRIDGE RD
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-5731
Country	:	US
Telephone Number	:	904-272-0800
Fax Number	:	904-272-4923

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	07/08/2007

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